ABSTRACT This application is in response to NOT-MD-19-023, which calls for proposals for expanding recruitment of projects to include Native Hawaiians / Other Pacific Islanders (NH/OPIs). Sleep disturbances, including short sleep duration, sleep apnea, and insomnia disorder, are highly prevalent among adults in the US and are associated with an increased risk for mental and physical health consequences including cardiometabolic disease. Comparative research studies indicate that sleep disparities are present in some minority populations; however, the extent to which sleep disparities exist across different racial/ethnic groups is not well known. Both Mexican-Americans and individuals from Native Hawaiian/Other Pacific Islander (NH/OPI) populations are at an increased risk for adverse sleep and corresponding cardiometabolic health outcomes, yet the role of potential mechanisms linking such deficiencies in these comparative minority groups is understudied. Factors that impact sleep functioning in one population may differentially impact another population. The overall goal of this project is to support and strengthen two aims of the parent grant by specifically including NH/OPI into the Nogales Cardiometabolic Health and Sleep study to further evaluate how acculturation, psychosocial stressors, and other social, environmental, and behavioral factors impact relationships between sleep disturbances and cardiometabolic disease risk similarly and uniquely, as compared to Mexican-Americans at the US/Mexico border. This project aims to determine how acculturation, economic hardship, psychosocial stress, and unhealthy behaviors (diet, exercise, alcohol, and smoking) are related to sleep disturbance by type in NH/OPI and in comparison to these relationships in Mexican-Americans. The second goal of this project is to determine how sleep and/or social-behavioral factors predict cardiometabolic disease risk among NH/OPI, as well as determine how these same factors are different in NH/OPI when compared to Mexican-Americans at the US/Mexico border. To accomplish these goals, this project will partner with researchers at the University of Hawaii to recruit and enroll N=100 NH/OPI to complete a battery of assessments from a clinic visit (questionnaires, interviews, exam for anthropometry, collection of biomarkers), a 1-night home sleep apnea assessment, a 24-hour ambulatory blood pressure recording, and a 2-week home monitoring period with sleep diary and actigraphy. Inclusion of NH/OPI into the larger dataset will facilitate a better understanding of sleep disturbances and the impact of factors that regulate sleep, including duration, insomnia symptoms, and obstructive sleep apnea, in relation to cardiometabolic disease risk within this population and in comparison to Mexican-Americans. The analytic plan will utilize a machine-learning analytic approach, which will be used to evaluate the complex relationships among all of these variables. This project will further address efforts at reducing sleep-cardiometabolic health disparities in minority populations by identifying potentially modifiable areas associated with community-based intervention programs.